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Cataracts in Children

Topic Overview

A
cataract is a painless, cloudy area in the lens of the
eye that blocks the passage of light to the retina, the nerve layer at the back
of the eye, usually causing vision problems. Cataracts are rare in babies and children. But a child may be born with them because
of genetics, infection during pregnancy, or low
birth weight.

The earlier cataracts are diagnosed and treated, the more likely it is that sight will be preserved or develop
normally. A baby's vision develops rapidly in the first few months of life. If
a cataract blocks light from entering the eye and stimulating the retina, the
area of the brain used for sight does not develop properly. And lazy eye (amblyopia) occurs. Without surgery in the first few months of life, the child won't ever see well with that eye, even if he or she has surgery later in life.

The signs of cataracts in children include the following:

The child may not look directly at or respond to
faces or large, colorful objects. An infant who cannot find small objects when
he or she is crawling on the floor may have cataracts.

The child
may scowl, squint, or shield his or her eyes more than expected when in bright
sunlight. This happens because of the glare caused by a cataract.

The child's
eyes may be misaligned and not focus on the same point at the same time (strabismus).

You may see a white reflex instead of a red reflex in your child's eye. For example, in a photograph of the child, one eye may appear white whereas
the other has the normal "red eye" look.

The affected eyes may have
repetitive wandering movements (nystagmus). This is usually a later sign of
cataracts. This sign may not develop until the infant is several months old. Removing
the cataract will probably not correct all of the vision loss at this
point.

If a child has a cataract in only one eye, you may not be able to
tell. All children should have regular exams by a family doctor to
screen for these types of cataracts.

Cataracts in infants are commonly detected at birth or during routine
well-child checks. More frequent exams are needed if the child has a medical
condition that increases the risk for cataracts, if he or she seems
to have trouble seeing, or if you notice your child has clouding of the lens.

Children who have vision problems from cataracts
usually need surgery to prevent lasting vision loss and to ensure normal vision
will develop. A small number of children with cataracts may benefit for
a short time from eyedrops that widen (dilate) the pupil. These eyedrops
increase the amount of light getting into the eye. The drops may also
help prevent vision loss in very young children who need to wait for surgery to be done.

Some types of cataracts in children require more urgent treatment
than other types:

Large, dense cataracts present from birth in the
middle of the lens that affect only one eye are more likely to cause permanent
vision loss. These cataracts need early diagnosis. And they will most likely need to
be removed promptly.

Smaller cataracts that are not causing
significant vision loss and are in only one eye may be treated by patching the
good eye. This strengthens sight in the eye with the cataract. Eyedrops that
enlarge (dilate) the pupil may also be used to increase the amount of light
getting into the eye. These treatments may prevent loss of vision until surgery
can be done, if surgery is needed.

Cataracts present from birth
that cover only part of the lens and that are in both eyes are least likely to
cause blindness. These cataracts may only need to be checked often by an eye
specialist (ophthalmologist) to see whether they are getting larger.

Call your child's doctor right away if you see that your child has one eye with a red reflex and one eye without it. The eye with the "white reflex" may have a cataract.

Call your child's doctor if:

Your baby does not look directly at or respond
readily to faces or large, colorful objects by age 2 to 3
months.

Your child scowls, squints, or shields his or her eyes more
than expected when in sunlight.

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